BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleedi...BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.展开更多
BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading ...BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ^(2) and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.展开更多
文摘BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.
基金The Medical Research Center(institutional review board,MRC-01-21-990)approved the study protocol at Hamad Medical Corporation,Doha,Qatar.
文摘BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ^(2) and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.
